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Healthcare Innovative Strategies: Changing Outcomes for Lewis Blackman
The “Lewis Blackman Story” told by Helen Haskell, a person who continues to advocate for change and improved quality of care. Lewis Blackman the son of Helen Haskell died at age fifteen after developing complications after surgery that included incorrect administration of a medication and a nursing team who failed to see the changes in patient’s condition and effectively and sufficiently respond to the change in a timely manner ultimately resulting in failure to rescue and the patient’s death. More specifically, the staff failed to recognize the signs of shock that this patient. Likewise, no rescue plan was in place. Lastly, failed protocols and failed leadership resulted in an unnecessary death of a patient. Much can be learned from this tragedy including the need for improved quality of care with implementation of innovative strategies. Nurses need to continue to work effortlessly to make the patient the center of care and work as a team with multiple disciplines to provide the best outcome for the patient.
Helen Haskell noted that the characteristics that make up a “good” professional nurse and/or physician included those that had proper training, the ability to rescue in emergency situations, orientation for nurses to deal with emergencies, continue to improve critical thinking skills, empathy for patients and families, and gain knowledge and have backup. From the Lewis Blackman story several innovative strategies can be deemed appropriate and likely have prevented this devastating scenario from occurring.
First, patient-centered care would have resulted in different outcomes. While this patient was a minor, patient-centered care also encompasses family and the professionals in the care of Lewis Blackman brushed off the mother’s request for the patient’s attending to evaluate the patient and obtain other opinions outside those of the Resident in charge and the newly trained nurse in charge of his care. Secondly, improvement in time and efficiency as more than 30 clinical hours passed before someone recognized the patient’s symptoms and realized the patient was getting inadequate IV fluids before it was changed by a seasoned nurse, however, it was too late. Thirdly, high quality leadership may have prevented this outcome.
Likewise, leadership at all levels including executive, middle, and front-line [direct care staff] is needed to achieve effective results and outcomes for patients. In the Lewis Blackman case, if more ‘seasoned’ staff would have been involved in the care of this patient earlier, it is likely that a different outcome would have resulted. This is merely and example of why having more Bachelors in Nursing (BSN) educated nurses working as direct care staff could prevent such adverse incidents from occurring and help to save lives and improve the overall quality of care at the bedside across the continuum of care settings. This is such a significant portion of improving the health and wellness and quality of care to patients that the Institute of Medicine (IOM) has made recommendations to improve the number of BSN educated nurses. This is directly related to improving the critical thinking skills of nurses and as a result different outcomes for patients. As care of the sick increases, and the acuity level rises with increased frailty of patients with complicated diseases, nurses have to make critical decisions more often than ever before (The Future of Nursing, 2010).
The Triple Aim
The Triple Aim as it relates to health care is about improving the quality of care, reducing costs and improving outcomes for patients in the care of health professionals. It is the goal to provide a higher quality of care and improving the patient experience achieving overall improved health for the United States population and decrease health care related costs (Berwick, Nolan, & Whittington, 2008). Patient centered care addresses the Triple Aim by making it a priority to provide better care, better health and lower costs. Studies have shown when patient centered care is provided; patients and families are more informed and educated to make realistic decisions about their health and well being.
Likewise, it also provides for a better patient experience when the patient is involved in the decision making of health care choices and the health care professionals, both, nurses and physicians listen to their patients and families and address concerns that arise. At the end of the day, this will reduce costs, unnecessary procedures, diagnostics, extended acute care stays and needless medical errors. In the case of Lewis Blackman, the Triple Aim would have been addressed if the team had involved the patient and mother in the plan of care. She spoke about the nurses not listening to her concerns. Had they listened to the mother’s concerns, the amount of hours before something was done to address the concerns and recognizing that the patient’s condition was rapidly changing could have resulted in a much different outcome.
This would have provided better care for the patient and the family. Had they listened, the patient still may be a live after having a simple elective procedure that would have resulted in better health instead of death. Making this patient’s stay with patient-centered care would have helped to reduce costs because Lewis Black likely would not have needed to be in the intensive care unit (ICU) which adds to health care costs. This would have saved the hospital money and prevented costs associated with the patient’s death.
One feels that the primary aim of the strategy, patient centered care is to provide better care by improved quality. Patient centered care provides for better care and in return provides for better health of the patient and lower costs from unnecessary extended stays or ICU needed interventions. In contrast, when better care is not provided to patients because patients are not the center of the care plan, health care spending and costs skyrocket and at times with the added costs still resulting in poor outcomes for the patient. Better health is not achieved when disability and other complications arise as a result of poor care.
IOM 6 Aims of Care
Institute of Medicine
The Institute of Medicine (IOM) described six aims of focus for the improvement of health and quality of care delivered to patients in the United States. These “six aims” for improvement in the IOM (2001) report identified the improvement for health care to be: Safe, effective, patient-centered, timely, efficient, and equitable and should be endorsed by all parties who have a stake in the matter. All groups involved in the public and private sector who use the health care system should adopt the six aims for the purpose of reducing the burden of illness, injury and disability and improve the health and function of the people in the United States (IOM, 2001).
In the Lewis’ case, if the institution that he died in would had focused on these six aims he may still be alive today. Even if they had only focused on just three of the six aims! If all six aims would have been addressed in Lewis’ case he would had remained safe during his elected procedure, the health care professionals in charge of his care would had developed a care plan that was patient centered and efficient that included listening to a concerned mother voicing noted problems and changes in her son. Thirty clinical hours would not have passed before this child was rescued and efficient care would have been provided because nursing staff would not be looking for equipment to monitor his vital signs and lastly, by meeting the five aims the professionals in charge providing care to this patient would have accomplished equitable care that does not vary in quality and based on the location of the procedure or unit that the patient was placed after having surgery.
The six aims that were violated in the care of Lewis Blackman include Safe, effective, patient-centered and timely care. Policy and practice would support the broken aims in Lewis’ case by implementing new protocols including rapid response teams that can help to rescue the patient when the patient is declining, effective follow up by assigned physician verifying the findings of the medical resident to assure safety and quality in the patients care. Furthermore, implementing new policies that require patient centered plan of care and require active participation by the patient and family with decisions and changes to care.
Drivers and Roadblocks for Change
The drivers of this paradigm shift in care concepts to improve quality, safe and effective care to patients in all health care settings are professional organizations such as the American Nurses Association, Institute for Healthcare Improvement, Robert Wood Johnson Foundation, National Institute of Health among others to lobby change in policy by public and private policy. Likewise, another driver is the evidence in research that shows a broken health care system when it comes to protecting patients and promoting health and preventing disease progression. Another driver for change would be to add a financial incentive to shifting care concepts to incorporate these six aims into practice and policy within private and public institutions.
As for roadblocks, many special interest groups voice concerns of change to political figures in Washington and at the state level that prevent implementation of government policy that improves care. Lobbying from health care corporations play a role in preventing the changes from occurring. “Increased lobbying and campaign contributions, many areas of the public health oversight have been deregulated and the staff available to monitor industry practices have been reduced” (Estes, et. al., 2013, p. 83). Money talks in Washington and as a result delays in policy changes to improve care are seen. There has been evidence that suggest corporations made decisions that have a direct effect on the health of the public that increase the United States mortality rate and morbidity (Estes, Chapman, Dodd, Hollister & Harrington, 2013). One also feels that a big roadblock is the financial burden that can take place on small organizations across the country if required by mandates to make changes. These initial costs can bankrupt organizations before long term costs savings can be seen.
The strategy of patient-centered care has long been an idea that would improve the patient experience within the healthcare system in this country. This strategy has been proved to work and research supports this claim. Many organizations are partnering together to implement this strategy throughout the country. The Institute for Healthcare Improvement (IHI) noted in 2011, that in order to achieve exceptional patient and family experience, their care must be patient-centered
Likewise, those who are more involved in their care are better able to manage complex conditions are more informed (Balik, Conway, Zipperer, & Watson, 2011) in order to make appropriate choices. This translates to improving the quality of the patient experience, reduce costs and simply give the patient a voice in the delivery of care they receive. This has resulted in government agencies such as the Centers for Medicare and Medicaid Services (CMS) to support this care approach and soon will be contributing reimbursement to the patient-centered care experience.
One alternative strategy to achieving the same goal is the one that has been used for years by hospices around the world and in this country. The hospice philosophy can be applied to other health care settings besides hospice and palliative care. This way of practice has been used for years in this country and is effective not only at end of life but can also be utilized during other areas of the health care continuum.
This strategy is providing holistic care that addresses health issues from a multidimensional perspective that encompasses mind, body, and spirit. This is achieved by utilizing an interdisciplinary approach that is mandated by regulatory bodies that a weekly interdisciplinary meeting take place that is only official if at least a social worker, chaplain, physician and a registered nurse case manager is assigned to patient and review the patients conditions, symptom needs minimally every 14 days to provide the best care. This is achieved by having an in-home centered care philosophy, which meets the needs of the patient in the community setting versus the acute care setting. This strategy addresses not only the patients needs but the families needs as well and is always patient centered care with the patient making health decisions with guidance from the interdisciplinary health professionals. This ultimately results in improved patient satisfaction; patient centered care, and is a more cost effective care strategy.
Based on one’s research of this strategy of patient-centeredness in care improves quality, safety and positive outcomes for patients. Several approaches are the most effective for the implementation of this strategy including starting with education and educating the workforce that is currently in practice as well as those who are entering nursing and medical schools. By redesigning the educational models within the college systems, future health care professionals will be better prepared to continue to implement this strategy and provide safe, quality and effective care with putting the patient at the center of medical and health care choices and outcomes while educating them on the benefits and risks they may face.
Secondly, with transformation that is taking place around the country to improve quality of care and outcomes including increasing the nursing education with the 80% with a BSN by 2020 as it continues to promote critical thinking and improved outcomes. Lastly, implementing policy changes that mandate this as a requirement and not a “great idea” in all settings across the continuum of health. One thinks that breaking this strategy down into sub portions and implementing one aspect at a time a crossed a period of time will be most effective in obtaining effective implementation.
This article was written by James Constanzer, registered nurse and owner of VitalLifeSenior.com an online retail senior care company founded to provide seniors with the best medical supplies, mobility equipment, vitamins and supplements they need to maintain a healthy, independent lifestyle.
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